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Clinical Articles, Lead Article

Electrical storm raises risk of death

Electrical storm (ES) is a potent risk factor for mortality and morbidity, according to research1 presented recently at the ESC Congress 2012. Data were also presented on which patients are prone to developing ES and how effective current treatments are.

The aim of the study was to collect all the data available regarding ES to see its real impact as a risk factor for death and impaired quality of life. The researchers conducted the largest meta-analysis of ES to date and pooled together 6,979 patients with implantable cardioverter defibrillator (ICD) implantation from 32 different studies. Dr Guerra said: “We sought to investigate whether there are any clues that enable us to predict ES, or at least tell us if some specific types of patients will be more prone to develop ES. Finally, we wanted to check what types of treatments are currently available for ES, and compare them in terms of efficacy and safety”.

The researchers found that ES was a strong risk factor for death. Compared to patients with multiple ventricular tachycardias (VTs) or ventricular fibrillations (VFs) but no ES, patients with ES were nearly four times more likely to die from cardiac causes, and five times more likely to experience either cardiovascular death, heart transplantation, or cardiogenic shock. Patients with ES were also nine times more likely to die from any cause than patients without any previous ventricular arrhythmias.

Dr Federico Guerra

Dr Federico Guerra

The researchers also found some specific subgroups of patients in which ES was more frequent. “Patients who had an ICD implanted because they have already experienced a VT or VF have the highest probability of developing ES,” said presenter Dr Federico Guerra (Marche Polytechnic University, Italy). “Patients with severe impairment of heart function and disabling symptoms of heart failure are also more prone to ES. And a specific subtype of VT, called monomorphic VT, is frequently followed by other arrhythmic episodes, which often culminates in ES”.

When the researchers analysed available treatments for ES they found that pharmacological treatment was often ineffective for terminating acute episodes or preventing recurrences. But Dr Guerra said: “The ablation of specific zones inside the heart by means of little catheters inserted from a peripheral blood vessel can provide effective termination of ES in nearly 83% of the cases, preventing relapses over the following years”.

“Our work confirmed ES as a potent risk factor for mortality and morbidity,” he added. “Even if it is still not possible to predict ES with certainty, our work helped to recognise specific subtypes of patients who are more prone to develop ES. Doctors can use this information to identify which of their patients are at risk of ES and take appropriate preventative measures. We also found that pharmacological therapy performs poorly in ES patients and should be accompanied by catheter ablation whenever possible, especially in a high-risk setting”.

References

1. Guerra F, Shkoza M, Scappini L, Flori M, Capucci A. Electrical storm: a strong mortality and morbidity risk factor. Is it possible to predict it? European Heart Journal 2012;33 (Abstract Supplement):189. http://spo.escardio.org/default.aspx?eevtid=54&hit=highlight-on

Published on: September 27, 2012

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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